Musculoskeltal system (health assesment)

Anatomy

Bones

  Joints

  Material between joints

• Cartilage 

• Bursa 

  Supportive structures of the joint 

• Ligaments

• Tendons 

Axial Skeleton

• Skull

• Spine

• Ribs

• Sternum

Appendicular Skeleton

Upper Extremities

• Scapula

• Clavicle

• Shoulder

• Elbow

• Forearm

• Wrist

• Hand

• Fingers

Appendicular Skeleton 

Lower Extremities

• Pelvis

• Hip

• Knee

• Ankle

• Foot

• Toes 

HISTORY GATHERING: MUSCULOSKELETAL

Family history – osteoporosis, OA/RA, or gout

Surgical history – orthopedic surgery or hysterectomy/oopherectomy

Medical history – personal history of musculoskeletal diseases

Medications – glucocorticoids or anticonvulsants

Injuries/ trauma – history of falls, previous injuries/fractures

Personal and psychosocial history 

• Exercise patterns

Smoking/alcohol us

work and recreational activities

HISTORY GATHERING CONT: MUSCULOSKELETAL
(OLD CARTS)

pain, swelling, decreased ROM, instability trouble w daily activities, muscle weakness/pain

START AT THE TOP AND WORK YOUR WAY DOWN AND REMEMBER TO ASSESS THE FOLLOWING BILTERALLY...

FORM – Inspect And Palpate 

FUNCTION – ROM (Range of Motion)  

STRENGTH – Provide Opposition To Two         Opposing Movements

Physical Exam: TIP 

Inspection & Palpate

• Symmetry

• Alignment

• Swelling  

• Deformities

• Redness
  Bony crepitus

• Pain or tenderness 

• Nodules or masses

• Bogginess

• Warmth

PHYSICAL EXAM:NECK (7 Movements)

Inspect  

Palpate 

Assess ROM (5 motions)

• Flexion

• Extension

• Hyperextension

• Lateral Flexion x 2

• Rotation – left and right 

Assess Strength (See Strength Scale) 

PHYSICAL EXAM: SPINE (7 Movements)

Inspect  

Palpate 

Assess ROM (5 motions)

• Flexion

• Extension

• Hyperextension

• Lateral Flexion x 2

• Rotation – left and right

Assess strength 

(See Strength Scale)

PHYSICAL EXAM:SHOULDER (8 Movements)

Inspect  

Palpate 

Assess ROM (5 motions)

• Flexion

• Extension

• Hyperextension

• Abduction 

• Adduction 

• Circumduction

• Internal rotation 

• External rotation 

Assess strength

 (See Strength Scale)

PHYSICAL EXAM: Elbow (3 Movements)

Inspect  

Palpate 

Assess ROM (3 motions)

• Flexion

• Extension

• Hyperextension

Assess Strength (See Strength Scale)

PHYSICAL EXAM: Forearm (2 Movements) 

Inspect  

Palpate 

Assess ROM (2 motions)

• Supination 

• Pronation 

Assess Strength

 (See Strength Scale)

PHYSICAL EXAM: Wrist (6 Movements) 

Inspect  

Palpate 

Assess ROM (6 motions)

• Flexion 

• Extension 

• Hyperextension 

• Radial flexion 

• Ulnar flexion 

• Rotation  

Assess strength 

(See Strength Scale)

PHYSICAL EXAM: Fingers (7 Movements) 

Inspect  

Palpate 

Assess ROM (6 motions)

• Flexion 

• Extension 

• Hyperextension 

• Radial flexion 

• Ulnar flexion 

• Rotation 

• Finger opposition  

Assess strength (See Strength Scale)

PHYSICAL EXAM: Hip (8 Movements)

Inspection

Palpation

• Flexion

• Extension

• Hyperextension

• Abduction 

• Adduction 

• Circumduction 

• External rotation 

• Internal rotation 

Asses Strength (See Strength Scale)

PHYSICAL EXAM: Knee (3 Movements)

Inspection

Palpation

• Flexion

• Extension

• Hyperextension

Assess Strength (See Strength Scale)

 PHYSICAL EXAM: Ankle and Foot (5 Movements)

Inspection

Palpation

• Dorsiflexion

• Plantar flexion  

• Eversion 

• Inversion 

  

• Rotation 

Assess Strength (See Strength Scale)

 PHYSICAL EXAM: Toes (5 Movements) 

inspection

Palpation

• Flexion

• Extension   

• Hyperextension  

• Abduction  

• Adduction  

Assess Strength (See Strength Scale)

MUSCULOSKELTETAL STRENGTH SCALE

Test opposite movements (ex:flexion/extension)

0- no evidence of contractility

1-evidence of slight contractility

2- complete range of motion with gravity eliminated

3- complete range of motion with gravity

4- complete range of motion against gravity with some resistance

5- complete range of motion against gravity with full resistance

Bone Abnormalities

Fractures

• Open vs Closed  

• Trauma

• Insufficient integrity

Osteoporosis

 loss of bone density increases risk of fracture 

Bone Abnormalities risk factors

• Age                                       

• Gender

• Race

• Thin/small boned

• Family history

• Lifestyle issues 

• Medications 

• Hormonal deficiency

• Eating disorders 

sedertary life style decreased calcium intake exessive alc

Joint Abnormalities

Rheumatoid Arthritis

• Chronic, systemic autoimmune disorder causing inflammation and erosion of the joints

• Fibrosis and shortening of the ligaments and tendons results in contractures and deformities 

• Pain and stiffness in the AM lasting more than 30 minutes

• Systemic symptoms of fever, anemia, and fatigue

Joint Abnormalities

Osteoarthritis

• Degenerative joint disease- breakdown of cartilage

• Pain in stiffness in the AM less than 30 minutes

• Pain decreases with movement

• Increased risk with age, females, obesity, joint injury or overuse, family history of OA

Spine Abnormalities

Herniated Nucleus Pulposus

• Herniated Disk/ slipped disk

• Fibrocartilage ruptures compressing spinal nerves

• Pain is dependent on where the disk is affected

Scoliosis

S-shaped deformity - Could be genetic

Kyphosis

Posterior curvature

Lordosis

Anterior curvature

Bursitis

• Inflammation of the bursa

• Pain, erythema, & tenderness at the joints

• Common in shoulder, elbow, and hip but also occurs in knee, heel, and MTP joint

Gout

• Increase in uric acid related to increased production or decreased excretion

• Typically occurs in MTP joint (base of the big toe) but can occur in any articular joint

• Tophi = uric acid crystal deposits in joints

Sprain

Injury to a ligament (connects bone to bone)  -  common in ankle and knee

Strain

Injury to a tendon (connects muscle to bone) or a muscle – common in Achilles tendon, low back, or quadriceps muscle

Tears

Partial or complete disruption of a structure  - meniscus, ligament, tendon, or muscle

Documentation

Gait steady with bilateral contralateral arm swing. No pain, tenderness, swelling, crepitus, bogginess, or inflammation noted in any joints. No deformities. No scoliosis, kyphosis, or lordosis. Full ROM with 5/5 strength testing in all extremities bilaterally.

Health Promotion

• Vitamin D/ Calcium intake

• Weight bearing exercises

• Smoking/ alcohol use

• Screenings

• Protection

Age Related Changes

• Decrease in bone mass

• Intervertebral disc space gets reduced

• Flexed posture

• Loss of muscle mass and strength due to decrease in tone of tendons and muscles

• Slower reflexes